Individual
BRECK SOUVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4460 S HIGHLAND DR, SALT LAKE CITY, UT 84124-3543
(888) 949-4864
Mailing address
7434 S STATE ST, MIDVALE, UT 84047-2014
(801) 456-9955
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
01/16/2019
Last updated
06/12/2019
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